- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $389.05 / $3,090.30 / $5,128.61
| Facility | | $389.05 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $426.58 / $977.24
| Professional | | $257.04 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,995.26 / $5,754.40
| Facility | | $524.81 | $1,995.26 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $3,090.30
| Professional | | $275.42 | $501.19 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $724.44
| Facility | | $316.23 | $316.23 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $891.25 / $1,659.59
| Professional | | $549.54 | $891.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $645.65 / $741.31
| Facility | | $199.53 | $645.65 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $489.78 / $1,071.52
| Professional | | $269.15 | $489.78 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $354.81 / $3,311.31
| Facility | | $229.09 | $354.81 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $588.84 / $851.14
| Professional | | $416.87 | $588.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $524.81 / $1,071.52
| Professional | | $288.40 | $524.81 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $1,995.26 / $5,754.40
| Facility | | $524.81 | $1,995.26 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $501.19 / $3,090.30
| Professional | | $275.42 | $501.19 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $524.81 / $3,548.13 / $9,120.11
| Facility | | $524.81 | $3,548.13 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $524.81 / $1,122.02
| Professional | | $281.84 | $524.81 | $1,122.02 |